So the underfunding of social care causes direct problems for the NHS by creating a shortage of beds and placing further pressure on hospital budgets.

It speaks to an incoherence and lack of vision that threatens the sustainability of both sectors and leaves patients missing out on the care they need.

The additional £3.8bn announced by George Osborne was, of course, excellent news.

The government has promised £8bn extra over this parliament and frontloading such a significant chunk of it will head off the immediate crisis and, just as importantly, allow for critical changes to begin - to begin - to be made to how the NHS operates.

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The head of NHS England, Simon Stevens, deserves credit for the way he lobbied the Treasury to make happen what right up until a late stage looked very unlikely.

But there was a sting in the tail of the spending review with cuts announced to public health budgets, which are managed by local government.

If the NHS is to become a sustainable, efficient service for the future we need to deliver the services that prevent ill-health from occurring in the first place and allow people to lead full and active lives.

It's an inexplicable decision that will only lead to greater pressures on the service in the future.

So again, we see immediate imperatives taking precedent over the long-term goals that are widely accepted.

In place of a closer - or even, total - integration of health and social care, we see separate budgets and the message to go it alone.

And instead of supporting the public health services that in the long term will ease pressure on both those sectors, we hear the familiar refrain: today is more important than tomorrow.

The big decisions are delayed and the trouble continues to build.

Clearly these are big picture issues but it is inevitable that short-termism is being replicated on a local level, at the sharp end where patients are.

The Mid Essex clinical commissioning group - one of 212 bodies across England that arranges and pays for non-hospital NHS services in their local area - says it must find savings of £15.6m next year.

To do so, it is proposing wide-ranging cuts and physiotherapy for common problems such as back or neck pain is among the services under threat.

It is proposing three options, including to remove the service entirely, and all of them are entirely driven by cost, rather than the best interests of patients.

But the point here is the short-term thinking that they illustrate.

The CCG must save money next year so it looks to stop spending so much in the next 12 months. On a basic level, that makes sense.

In reality, however, cutting or deleting the service will only bring greater costs.

If patients can't get access to the treatment they need, their condition will worsen and they will need more expensive care, possibly in the form of surgery.

At the very least, they will keep having to go back to their GP at a greater cost to the NHS than seeing a physiotherapist.

This, of course, is leaving aside the human cost of patients being forced to remain in pain for longer, possibly causing them to miss work and certainly impacting on their quality of life.

It's unacceptable - but not necessarily surprising.

The scale of the CCG's savings target - in one part of one county - demonstrates the extreme financial stress the NHS is under.

Commissioners in all parts of the NHS are having to make awful decisions under great pressure and up against the clock.